5 Misconceptions Surrounding Exercise and Endometriosis, Debunked
On an endometriosis flare-up day, getting out of bed can feel akin to scaling a building. With symptoms like the pelvic pain and constant trips to the bathroom, the condition is a debilitating disease that manifests differently in each person. And for 190 million people worldwide, it can make daily lifestyle activities difficult.
Endometriosis (commonly abbreviated to endo) is a chronic, inflammatory disease, says a gynecologist and minimally invasive surgeon. “There are little, itty-bitty things in our bodies in places they should not be,” she says. Tissue that resembles the uterine lining—known as lesions—grows in places it doesn’t belong, causing to severe pain.
The best lifestyle practices for living with endometriosis are often debated. There have been studies conducted on animals surrounding the link between exercise, stress and pain; though research in humans remains insufficiently researched. One study even suggests individuals with the condition might benefit from avoiding intense exercise as it could trigger inflammation—but notes that more research needs to be done to confirm those findings.
For many with the condition, though, waiting for answers isn’t in the cards. Shelle Tarver a personal trainer, can’t imagine giving up or short-cutting fitness despite her condition. She often posts videos on social media about how to navigate working out and living with endometriosis, and has received positive feedback from others just like her.
“I have endometriosis. I love to work out. I'm not going to let that stop me from doing it,” Tarver says. “I'm just going to figure out how I can do it.”
And of course, there are clinical benefits to exercise that everyone (including those with endometriosis!) can benefit from, says Dr. Hawkins. Movement releases endorphins, promotes flexibility, eases inflammation, and improves circulation.
Still, there’s so much misinformation regarding fitness and endometriosis swirling around the internet—particularly because research and clinical advice is so limited. So, we hit up the experts. Here is what they had to say.
5 Myths About Exercise and Endometriosis, Debunked
1. Exercise—specifically frequent exercise—is bad.
Lets put this one to rest: The notion that exercise is bad for endometriosis is not true. Having a chronic condition can hinder your ability to do a lot of things—but it shouldn’t stop you from having workout goals and taking steps towards achieving them.
“One thing that people misconceive is that [fitness for endometriosis] is the same for everyone,” Dr. Hawkins says. She often sees people with endometriosis saying they cannot and should not exercise in social media posts. “That [person] with endo can't do it—it doesn't mean you can't do it,” she says. “And it doesn't mean that it wouldn't be helpful for the complexity of your particular body.”
Some research shows that regular physical activity can also help “improve hormonal regulation and support psychological well-being” in those with the condition, says Maya Lespinasse, PT, DPT, Cert-DN, and founder of How’s Your Pelvis? Physical Therapy and Wellness LLC. She even recommends about three days of exercise per week to her patients.
“For chronic pain in general and mental well-being, I do encourage sweating,” she says. “Going on a walk or running—whatever they like. Getting that blood flow and anti-inflammatory system going does seem to help.”
In an ideal world, exercising every day would be optimal, Dr. Hawkins says. “But that's not realistic for a lot of women.”
For some, exercise can help with endometriosis symptom management—for others, not so much. It’s about discovering what level of exercise makes you feel best in your body. Even “maintaining some type of intentionality about remaining flexible and also remaining relaxed, even if it's just breathing exercises right before you go to bed, can be helpful,” Dr. Hawkins says.
2. Those with late-stage endometriosis in particular should avoid exercise.
Endometriosis is unique and complex. Although it is classified in four stages of progression—minimal to deep-infiltrating—stage does not necessarily correlate with level of pain.
“I've had patients with deep-infiltrating Stage 4 endo and they have no idea. They feel great,” Lespinasse says. “And then I have patients with Stage 1 [that] can't get out of bed.”
Given these nuances, both Dr. Hawkins and Lespinasse say that the right amount and intensity of exercise largely depends on the person. For some, a Pilates session may worsen pain. For others, that type of fitness eases inflammation. There is no right and wrong way to exercise with endometriosis, but there can be a right and wrong way for your particular body.
In general, though, fitness isn’t something to fear just because you have the diagnosis. Seeing what movements work for your body and moving on from there can be the safest approach.
3. Exercise should look a certain way.
There is not “one” way to exercise with endometriosis. And traditional exercise is not the only way to relax muscles and release tension.
“A massage, even though some people wouldn't consider that exercise, is a form of stimulating our muscles, our lymphatic system, and our circulation,” says Dr. Hawkins. “Some people that live with chronic debilitating diseases such as endometriosis do quite well from getting massages.”
Lespinasse notices that a lot of people with the condition also don’t breathe correctly. When she works with those actively experiencing a flare-up, she focuses on improving that first, as well as strengthening their pelvic floor with moves like cat-cow.
“Child's Pose with diaphragmatic breathing (intentional deep breathing into your belly), Happy Baby, hip stretches, inner thigh stretches, any adductor stretches, piriformis stretches, [and] back mobility exercises” are additional movements that can help those in pain, she says.
4. High-intensity workouts and strength training is bad.
Just because you suffer with endometriosis doesn’t mean low-intensity fitness is your only option. Marianna De Vita, NASM CPT, is living proof of it. She chooses powerlifting instead.
DeVita received an endometriosis diagnosis and surgery in 2022, after suffering with severe symptoms the year prior. “I couldn't eat. I couldn't sleep. I was in so much pain and I lost the ability to walk,” she reflects. “I just never wanted to feel that weak ever again.”
That experience was the reason she turned to the gym. Now, as a powerlifter, DeVita doesn’t let her condition limit her workout goals—and adjusts her workouts when she’s not feeling 100 percent.
“I usually try to do low reps in moderate weight on the days that I'm not really feeling that good,” says DeVita. On days when she feels nausea, abdominal and leg pain, and bloating, she finds relief in bench pressing.
“Any laying exercises are really good for me. Your core isn't really compressed when you're benching, and it's mostly focused on your upper body,” DeVita says. “It's definitely easier to do [without] exacerbating symptoms when my legs and my pelvis are really sore.”
Of course, what works for DeVita might not work for everyone. Still, she says, “If somebody really wants to do it, it's not a definite no. It's just learning your body, like with what I've done, and having the correct doctors and medications.”
When it comes to high or low intensity fitness, listening to your body and knowing when to push and when to stop is important for discovering what you might be capable of.
5. Exercise following surgery is bad.
Laparoscopic surgery—a minimally invasive procedure done to remove endometriosis lesions—is one of the most effective diagnostic and treatment methods. Although there is no cure for the condition at this time, the surgery has shown positive results for symptom relief and fertility.
Getting proper rest post-operation is crucial to healing and recovering properly, but that doesn’t mean you can’t move at all. Dr. Hawkins usually tells patients to avoid strenuous exercise for the first four to six weeks following surgery, but light walking can aid with swelling and reduce the risk of blood clots.
“In those early days, really just focus on rest, heat, [and] gentle mobility. Lying on your back [and] shifting your leg side to side” tend to be the safest movements, says Lespinasse. She advises consulting a specialist or physical therapist for personalized post-operative guidance first, though.
After this initial period, you can start to push your body more, says Dr. Hawkins. Testing your limits and seeing what feels good for your body is all part of the process. Plus, you might discover you can do more than you could before after you’re fully healed.
“Before and after surgery sometimes can look different,” Dr. Hawkins says. “Maybe I could not get to that full weight, or not do that press, or not get that yoga pose before surgery. And here I am now, after surgery, thriving and [doing] the things that I thought my body couldn't and wouldn't let me do.”
Tips for Exercising with Endometriosis
Fitness is possible for you, chronic condition or not. Here are some tips for adding exercise to your routine.
Targeting your pelvic floor and core can help ease tension and discomfort.
As an inflammatory condition, endometriosis is often associated with “increased muscle tension in the abdomen and in the pelvic floor, [and] changes to the lymphatic system,” says Lespinasse. Movements that focus on downtraining—relaxing—pelvic floor tension and mobility can help with symptoms like this, she says.
As a personal trainer, Tarver also focuses on the pelvic region when working with her endometriosis clients. “The biggest thing is core and hip stability because if you can get those to work together, those can continue to get stronger,” she says. She focuses on strengthening the pelvic floor muscles with moves like glute bridges and dead bugs with a Pilates ball.
It bears repeating—exercise effectiveness for those with endo vary largely from person to person. For best guidance, talk to a health care specialist to find the right workout plan for you.
Staying prepared can help make flare-up days more manageable.
There’s nothing worse than a flare-up catching you off guard, especially at the gym. Keeping your gym bag stocked in advance with supplies that bring you relief can make those moments a bit less stressful.
For DeVita, having things like Pepto-Bismol, workout snacks, and a transcutaneous electrical nerve stimulation (TENS) machine—a stimulation device that studies show can help with flare-up pain—in her gym bag helps her stay ready for bad days.
Tarver also keeps a few things on-hand when she goes to the gym, including ibuprofen, tea bags, and heating pads.
The Bottom Line
"I just want people to know that [working out] is possible,” DeVita says. She may have to work a bit harder, and not negate rest when her body needs it, but she has made fitness an essential part of her life.“That's what makes people with endometriosis so strong and great—we have so many extra things we have to worry about, but we still do the same things as everyone else.”
You don’t have to let this disease keep you from living a fit lifestyle. Talking with your doctor, seeing a personal trainer, and testing your workout capabilities can help you enhance your overall well-being.